(Select All That Apply): A nurse is assessing a client for major depressive disorder (MDD). Which of the following signs and symptoms are consistent with the clinical presentation of MDD? Select all that apply.

Choice A rationale:

Bipolar disorder involves both depressive episodes and manic episodes. The client in question denies any history of manic episodes, making bipolar disorder less likely as a diagnosis. Manic episodes are characterized by elevated mood, increased energy, impulsivity, and risky behavior.

Choice B rationale:

Dysthymia, also known as persistent depressive disorder, involves chronic feelings of sadness and a lack of interest or pleasure in activities. It is a milder form of depression that persists for at least two years in adults. The client's persistent feelings of sadness align more closely with the criteria for dysthymia.

Choice C rationale:

Substance-induced mood disorder occurs when the client's mood disturbances are a direct result of substance use or withdrawal. Since there is no mention of substance use or withdrawal in the client's history, this choice is less relevant to the scenario.

Choice D rationale:

Adjustment disorder is characterized by the development of emotional or behavioral symptoms in response to an identifiable stressor, and these symptoms typically resolve within six months of the stressor's resolution. In the scenario, there is no indication of a recent stressor, and the client's symptoms seem to be chronic rather than time-limited, making adjustment disorder less likely.

Choice A rationale:

Positive life events, although beneficial, are not typically considered contributors to the development of depression. Positive events generally have a positive impact on mental health and may even serve as protective factors against depression.

Choice B rationale:

High income is not commonly recognized as a direct contributor to depression. In fact, higher income can provide access to better resources and opportunities that might contribute to better mental health outcomes.

Choice C rationale:

Lack of social support is a well-established factor contributing to the development of depression. Social support plays a crucial role in buffering against stress and providing individuals with a sense of belonging and emotional connection. A lack of strong social ties can lead to feelings of isolation and increase vulnerability to depression.

Choice D rationale:

Optimistic thinking is typically considered a protective factor against depression rather than a contributor to its development. Optimistic thinking involves a positive outlook on life and the expectation of positive outcomes, which can act as a resilience factor against depressive symptoms.